Pharmacology Final Key Concepts Flashcards
Contraindications for Calcitonin?
Hypersensitivity to fish products
How does Calcitonin work?
Treats Osteroporsis, and Biphosphates do too. It is a thyroid horomone that inhibits the action of PH and stops it from being absorbed by the bone. Regulates calcium and bone metabolism
How to store Calcitonin?
Store unopened bottle (nasal drug formulation) in the refrigerator between 36 and 43 degrees F.
Once the pump has been activated, store at room temperature
What should the nurse be aware of with calcitonin?
Causes serum calcium level to drop, which results in tetany and cardiac arrhythmias.
How do the biphosphates work?
Inhibits normal and abnormal bone absorption.
Treats hypercalcemia to increase bone resorption of calcium, and in treating osteoporosis.
Patient teaching for Biphosphates
Take each tablet upon rising in the morning with a full glass of plain water (6-8 oz), and at least 30 minutes before ingesting any other medicaions, food, or beverages.
Vitamin D is needed in order for it to be effective.
Must not take it before going to bed or before getting out of bed in the morning.
Differences between Calcitonin and Calcitriol?
Calcitonin is a peptide hormone that limits calcium levels by inhibiting the intestinal uptake and bone release.
Calcitriol is a form of vitamin D that stimulates the intestinal absorption of calcium, stimulates calcium’s release from the bone, and stimulates calcium’s reuptake by the kidney.
How does Prazosin work to treat BPH?
Selectively and competitively blocks postsynaptic alpha-1 adrenergic receptors,decreaes sympathetic tone anddilates arterioles and veins.
This results in decreased peripheral resistence and decreased blood pressure.
Wat drugs are used in shock to raise vital signs?
Dopamine & Epinephrine, which are adrenergic agonists so they stimulate the sympathetic nervous system.
What do adrenergic agonists or anticholinergics do to the body when stimulated? (sympathetic nervous system stimulation)
Pupils dilate Sallivary glands secrete fluid Heart rate increases, Heart contractility increases Coronary arteries dilate Trachea and bronchioles dilate Blood vessels in the skin and mucous membranes constrict Sweat is produced GI motility and tone decreases GI sphincters contract Ureter and bladder relaxes Ejaculation is stimulated in bed
What do cholinergic agonists and adrenergic antagonists do to the body?
Pupils constrict Tears flow Salivary gland secretes watery fluid(instead of viscous fluid in sns) Trachea and bronchioles constrict and secretions decrease GI glands produce more secretions GI motility increases (incontinence?) Lower colon contracts Ureters and bladder contract Penille erection stimulated in mend
What does Methimazole do?
Inhibits the synthesis of the thyroid hormones (T3 and T4) so they are not produced.
Therefore it lowers thyroid levels and is used to treat hyperthyroidism in Graves Disease
Nursing considerations for Methimazole?
Administer around the clock at 8-hour intervals
What other thing can Methimazole be used for?
Used to prepare someone for having their thyroid removed (thyroidectomy) in order to get them used to having a lower function of thyroid and less/ thyroid hormone circulating in the body.
If someone complains of being depressed, what could this possibly mean?
Hypothyroidism so assess for it.
Lethergy weight gain anxiety impaired memory constipation hypotension bradycardia intolerance to cold loss of hair decreased sexual function menstrual irregularities infertility edema of the hands and feet and face, pale and rough skin, thickened tongue,and a husky voice
are what you would see in what condition?
Hypothyroidism
Tachycardia, signs of an overactive cellular metabolism of all body systems, tachycardia, palpitations, hypertension, increased body temperature, heart intolerance, weight loss, ameonorrhea and goiter are clinical manifestations of what disease?
Hyperthyroidism
What is Levothyroxine used for?
Replacement therapy in hypothyroidism
Also can be used for subacute thyroiditis, or for the suppression of thyroid stimulating hormone in managing hypothyroidism secondary to thyroid cancer, and in treating myxedma coma.
How does Levothyroxine work?
Replaces natural thyroid hormone
What adverse effects can Levothyroxine do?
Cause symptoms of HypERthyroidism. Fast heart rate etc
Basal Insulin
the continuous secretion that maintains glucose homeostasis, that is, the
body’s baseline level of insulin.
Correctional Insulin
In addition to the basal and prandial doses, patients with diabetes
who are ill and hospitalized may also require some correctional (or supplemental) insulin doses to correct any elevations in blood glucose, with the goal of keeping the blood glucose close to normal at all times, because the physiologic stress of illness increases glucose levels. Some medications can also increase glucose levels
Diabetes Mellitus
Type 2 diabetes is the result of insulin resistance by the tissues and usually a decrease in insulin production. Abnormalities of carbohydrate, fat, and protein metabolism occur in type 2 diabetes. Type 2 diabetes is linked closely to obesity, sedentary lifestyle, and lack of physical activity; scientific experts declare that the dramatic rise in the number of patients with this type of diabetes is attributable, in great part, to America’s weight problem
Diabetic Ketoacidosis
Because the circulating glucose is not accessible to the cells, the
body mistakenly interprets this to mean that there is not enough glucose and thus initiates two other processes to gain energy: breaking down lipids and breaking down proteins. The increase in lipid metabolism leads to an increase in ketoacids, causing ketoacidosis (metabolic acidosis of diabetes). The breaking down of proteins leads to muscle wasting, constant weakness, and weight loss. By the time the signs and symptoms of type 1 diabetes appear, most pancreatic beta cells have been destroyed. Occurs in type 1 diabetes
Gestational diabetes mellitus
occurs when a woman’s pancreatic function is not sufficient to overcome the insulin resistance created by the anti-insulin hormones secreted by the placenta (e.g., estrogen, prolactin, cortisol, and progesterone), as well as the increased fuel consumption needed for the mother and the fetus. Diagnosis and treatment are essential because the severe hyperglycemia that can result is associated with increases in the incidence of preeclampsia, fetal macrosomia (i.e., large infants), birth trauma, and perinatal mortality
Gluconeogensis
Glucocorticoids cause an increase in gluconeogenesis and a decrease in glucose utilization, causing HYPERGLYCEMIA to occur.
Glycogenolysis
breakdown of glygogen to glucose
Glycposylated Hemoglobin
Hemoglobin molecules react with glucose molecules and form glycosylated hemoglobin. This process is increased when blood glucose levels are elevated, such as in diabetes. Because this reaction of glucose with hemoglobin will last the life of the red blood cell it is possible to determine a patient’s blood glucose level
Prandial Insulin
Insulin that is secreted in response to meals
Metabolic Syndrome
This syndrome is a combination of conditions, namely insulin resistance with a compensatory hyperinsulinemia to maintain glucose homeo-stasis; obesity (especially abdominal or visceral obesity); dyslipidemia characterized by high triglycerides, low high-density lipoproteins (HDLs), or both; prothrombotic state (e.g., high brinogen or plasminogen activator inhibitor); pro-in ammatory state (e.g.,elevated high-sensitivity C- reactive protein in the blood); and hypertension (130/85 mm Hg or greater).
Non ketotic hyperglycemia
Insulin is present but not as effective
Dawn Phenomenom
when blood glucose levels are at their highest between 5 am and 6 am. The release of growth hormone overnight is believed to produce this increase in blood glucose. Dawn phenomenon is treated by providing larger doses of intermediate-acting insulin at bedtime to prevent early-morning elevations of glucose.
The Somogi Effect =)
The Somogyi effect also produces early-morning hyperglycemia, but the precipitating factor is actually a hypoglycemic event sometime after midnight. The body compensates for the low blood glucose by using counter-regulatory hormone release, directing the liver to release glucose to restore the glucose level to normal. When the body overcompensates, rebound hyperglycemia occurs. The Somogyi effect is treated by lowering the insulin dose, increasing the dietary intake at bedtime, or both.
Type 1 Diabetes
an autoimmune disorder characterized by the destruction of the insulin-secreting beta cells in the pancreas, leading to absolute insulin deficiency.The body’s reserve of insulin is depleted, resulting in hyperglycemia (abnormally high blood glucose). Because the circulating glucose is not accessible to the cells, the body mistakenly interprets this to mean that there is not enough glucose and thus initiates two other processes to gain energy: breaking down lipids and breaking down proteins.
The increase in lipid metabolism leads to an increase in ketoacids, causing ketoacidosis (metabolic acidosis of diabetes).
The breaking down of proteins leads to muscle wasting, constant weakness, and weight loss.
By the time the signs and symptoms of type 1 diabetes appear, most pancreatic beta cells have been destroyed.
What is Glucagon?
Glucose-elevating agent that accelerates hepatic glyconeogenesis, increasing blood glucose levels. Glucagon also plays a role in regulating the blood glucose level. Glucagon is a small protein hormone, and declining blood glucose levels stimulate its release from pancreatic islet alpha cells. Sympathetic nerve impulses, exercise, infection, and trauma also stimulate its release. In the liver, glucagon stimulates glycogenolysis and gluconeogenesis, resulting in a release of glucose into the blood.
What might need to accomany glucagon in someone with hypoglycemia and why?
A carbohydrate, because it is short acting! And you need something that will sustain the glucose level for longer.
Differences in adverse effects in Oral Insulin vs. Subcutaenous Insulin
Repetive Subcutaenous injections of insulin intomthe same injection site can cause disturbances in fat metabolism. It causes Lipodystrophy as an adverse effect, which can present as either lipidstrophy, which causes SC fat to break down, or lipid hypertrophy, which causes additional fat deposits at a particular site.
They both delay insulin absorption, which can mess up pharmacotherapeutics. Sub-Q is also short acting and it can cause weight gain.
Oral insulin can cause hypoglycemia.
What are sub-Q and oral insulins prescribed this way?
Sub-Q insulin, which is regular insulin, has a quick onset and short duration, which means that it can be given to a patient several times a day.
With IV insulin, up to 80% but usually 20-30% of the insulin is lost because it is absorbed into the plastic tubing set.
What assessment would you complete for someone taking regular insulin?
Nurse should assess for changes in their normal routine, such as missing meals or unexpected exercise.
Exercise can decrease the need for insulin.
The nurse should ask about the patients usual activity level, occupation, amount of recreational activities, and daily exercise.
Also should assess typical eating habits.
You might need to increase the amount of times that they check their blood glucose level or increase the sliding scale.
What is the result of missing dosages of antibiotics and not taking antibiotics as prescribed?
Causes antibiotic resistence which allows organisms to repopulate and re-establish an infection
What causes Multiple Drug resistant Mycobacterium Tuberculosis?
Inadequate drug therapy, which can include a dose that is too low, the duration of therapy being too short, or the patient stops taking the medication as prescribed.
What are a culture and sensitivity?
Culture determines what the microbe is, Sensitivity determines which antimicrobial agent will be therapeutic.
Most important patient education in antimicrobial therapy?
Complete the entire course of antibiotics, take the prescribed dose at the prescribed intervals.
What is lsoniazid used for?
Prophlyaxis and management of TB
Important concern for patients taking Isoniazid?
Causes liver toxicity/Hepatotoxicity!
Isoniazid contraindications
Acute hepatic diseases
How to administer Isoniazid
On an empty stomach
What causes multindrug resistant TB???
Nonadherence to therapy
How long to patients who are on multi drug therapy for TB have to have therapy?
6-24 Months
When Glucocorticoids are used to treat asthma, what side effects do they cause?
Suppression of HPA axis which may lead to secondary adrenal insufficiency. Abrupt withdrawl may cause adrenal insufficiency too.
So they must be withdrawn gradually‘to prevent this!!!
*Can also cause Cushingoid characteristics which includes the redistribution of fat deposits (such as getting a buffalo hump, moon face, and trunkal obesity) * also vision changes and muscle wasting.
Prednisone can cause:
Long term can also cause osteoporosis in women which puts patients at risk for fractures, bone loss, and can als impair glucose tolerance in patients with type 1 and 2 diabetes..
How do glucocorticoids affect people with diabetes??
Prednisone, the prototype, can affect Glucose tolerance.
Patients with diabetes taking this drug may need to change their diet or hypoglycemic therapy to maintain theirndrug sugar.
Can also alter glucose tolerance tests.
Glcucocorticoids can also do what to glucose ?
Increase gluconeogenesis and decrease glucose utilization, which causes hyperglycemia!!!
Patient education for those using inhalers?
Clean/Rinse equipment after each use to decrease the risk of infection
What can the overuse of laxatives do to the GI sphincters?
Can cause incontinence
Infants skin permeability is what compared to an adult? How does this affect drug absorption?
Infans skin permeability is greater and they have an increased body surface are which increases the absorption of topical agents.
This is important bc it may result in adverse effects that do not usually occur in an adult patient.
